In 2015, Wendy Hall, a paediatric sleep researcher based in Canada, studied 235 families of six- to eight-month-old babies. The purpose: to see if sleep training worked.

By its broadest definition, sleep training can refer to any strategy used by parents to encourage their babies to sleep at night – which can be as simple as implementing a nighttime routine or knowing how to read an infant’s tiredness cues. Tips like these were an important part of Hall’s intervention.

So was a strategy that has become commonly associated with “sleep training” and tends to be far more divisive: encouraging babies to put themselves to sleep without their parents’ help, including when they wake up at night, by limiting or changing a parent’s response to their child. This may mean a parent is present, but refrains from picking up or nursing the baby to physically soothe them. It can involve set time intervals where a baby is left alone, punctuated by parent check-ins. Or, in the cold-turkey approach, it may mean leaving the baby and shutting the door. Any of these approaches often mean letting the baby cry – hence the common, if increasingly unpopular, moniker “cry-it-out”.

In their study, Hall and her team predicted that the babies whose parents were given instructions for sleep training along with advice would sleep better after six weeks than those who were not, with “significantly longer longest sleep periods and significantly fewer night wakes.

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A number of studies, for example, have been non-randomised, with parents deciding on the method of treatment themselves. This makes it hard to prove cause and effect. For example, parents who have reason to think their babies will only cry for a short while (or not at all), then fall asleep, may be more open to trying out controlled crying to begin with – which could skew results to make it seem more effective than it is. Alternately, it could be parents whose babies really struggle to fall asleep by themselves that are more drawn to the method, making it look less effective than it is. And, of course, the difficulty of studying something like sleep training is that even in a randomised trial, parents assigned a controlled crying method may decide against it – so a “perfect” study is impossible to set up. Many trials often have high drop-out rates, meaning parents who found sleep training especially difficult may not have their experiences reflected in the results.

Meanwhile, the majority of studies rely on “parent report”, such as questionnaire responses or sleep diaries kept by the parents, rather than using an objective measure to determine when a baby is awake or asleep.

Meanwhile, the majority of studies rely on “parent report”, such as questionnaire responses or sleep diaries kept by the parents, rather than using an objective measure to determine when a baby is awake or asleep. But if a child has learned not to cry when he wakes, then his parents might not wake, either – which could lead them to report that their child slept through the night.

As a randomised controlled trial, half of the parents were instructed in what’s called either “graduated extinction”, “controlled comforting” or “controlled crying”: soothing a crying baby for short increments, then leaving them for the same amount of time, with intervals gradually getting longer regardless of the child’s response. For parents who were “really uncomfortable” leaving their child crying alone in the room, Hall says, the researchers advised staying in the room – but not picking the child up – in an approach called “camping out”.

The intervention group also received tips and information about infant sleep, such as myth-busting the idea that fewer naps would lead to more nighttime sleep.

When the researchers compared sleep diaries, they found that parents who had sleep-trained thought their babies woke less at night and slept for longer periods. But when they analysed the sleep-wake patterns as shown through actigraphy, they found something else: the sleep-trained infants were waking up just as often as the ones in the control group. “At six weeks, there was no difference between the intervention and control groups for mean change in actigraphic wakes or long wake episodes,” they wrote.

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